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Major indication: paracetamol poisoning

  • patients with paracetamol level above or just below treatment line
  • all patients with potentially hepatotoxic overdose (> 150 mg/kg). Treatment can be stopped if paracetamol concentration is below standard treatment line but this approach avoids potentially fatal delays in treatment
  • all patients with evidence of severe toxicity or fulminant hepatic failure, regardless of time since overdose
  • high risk patients (eg chronic alcohol abusers, malnutrition, HIV infection) with depleted hepatic glutathione, patients on enzyme inducing drugs (eg rifampicin, anticonvulsants, alcohol): start treatment at paracetamol levels half those of the standard treatment line
  • patients unable to give a reliable history or who have taken a sequential overdose over several hours

Other indications

  • toxicology: to prevent hepatotoxicity due to CHCl3 or CCl4 or neuropsychiatric sequelae of CO poisoning
  • cardiology: to reduce tolerance to prolonged GTN infusion; in severe unstable angina and acute MI
  • acute lung injury
  • acute hepatic failure
  • oncology: to prevent cardiotoxicity of doxorubicin and reduce haemorrhagic cystitis due cyclophosphamide and ifosfamide

Unproven or untested

  • anti-HIV therapy
  • other conditions in which damage is caused by reactive metabolites, oxygen free radicals or depletion of glutathione


At usual doses

  • local skin reactions
  • anaphylactoid
  • hypertension


  • severe anaphylactoid reactions
  • respiratory depression
  • haemolysis
  • DIC
  • renal failure
  • ARDS
  • GI haemorrhage
  • death

© Charles Gomersall December 1999


©Charles Gomersall, April, 2014 unless otherwise stated. The author, editor and The Chinese University of Hong Kong take no responsibility for any adverse event resulting from the use of this webpage.
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